Healthcare Provider Details

I. General information

NPI: 1669757944
Provider Name (Legal Business Name): GRANCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 TATUM AVE
GRENADA MS
38901-4632
US

IV. Provider business mailing address

347 TATUM AVE
GRENADA MS
38901-4632
US

V. Phone/Fax

Practice location:
  • Phone: 662-226-8878
  • Fax: 662-226-8879
Mailing address:
  • Phone: 662-226-8878
  • Fax: 662-226-8879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RONNIE RESPESS
Title or Position: GENERAL PARTNER
Credential:
Phone: 662-226-8878